Depending on their clinical situation and the portal venous pressure, between 30% and 85% of cirrhotic patients have esophageal varices (EV) ( 11, 12). The lifetime risk of liver-related death is about 40%-50% for men ( 8, 9) and 15% for women ( 10).
The younger the patients at the time of infection, the higher is the progression rate from acute to chronic hepatitis B infection, decreasing from 90% for an infection acquired perinatally to lower than 5% in adults ( 6, 7). In North Korea, it can be assumed the transmission of hepatitis B to occur mostly vertical ante- or perinatally and sexually, however, there are no data on the exact transmission rates ( 6). Given the high natural prevalence in the region of up to 20% ( 5) and the North Korean deficits in vaccination, the true prevalence can be assumed to be even higher. According to verbal statements on unpublished data from a survey among North Korean refugees to South Korea, a prevalence of 9% is more realistic ( 4). The World Health Organization (WHO) calculated a prevalence of 4.5% in 2003. Hepatitis B is endemic in the Korean Peninsula ( 3).
The prevalence of hepatitis B in North Korea can thus only be estimated. Hepatitis B is one of the most important public health problems the Democratic People's Republic of Korea (DPRK, North Korea) is currently facing, because of its high prevalence combined with an often deleterious chronic course leading to both physical impairment and sufferings of the patients as well as causing a huge socio-economic burden ( 1).ĭue to its present political and economical situation North Korea faces limitations in obtaining epidemiological data on diseases or health related problems ( 2). Parts of the project can serve as an example for other low-income countries, however its general transferability is limited due to the special circumstances in North Korea. The bi-modal preventive strategy was implemented successfully. A clinical standard operating procedure, a feedback system and a follow-up plan were developed. A total of 11 hepatitis B-induced liver cirrhosis patients (mean age 41.1 yr) with severe esophageal varices and previous bleedings were successfully treated by EVL without major complications. By vaccinating 7 million children between 20, the hepatitis B vaccination gap was closed. Part 2: Implementation of endoscopic ligation of esophageal varices (EVL) by trainings in Germany and North Korea. Part 1: Hepatitis B vaccination catch-up campaign. The feasibility of a joint North Korean and German humanitarian hepatitis B prevention program was assessed. Aid projects are urgently needed, however impeded by North Korea's political and economical situation and isolation. In North Korea, the prevalence of hepatitis B is high due to natural factors, gaps in vaccination, and the lack of antiviral treatment.
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